OA0000002579667 (RAYMOND) (NEW)

Male Others Female 01. Full Name: Last / Surname 02. Permanent Address: Contact No.: Email: 03. Address in Bangladesh: DD / MM / YYYY 04. Date of Birth: 05. Sex: 06. Place of Birth: 07. Present Nationality: 08. Nationality at Birth: 09. Occupation: 10. Marital Status: RAYMOND ADRIANO CABUSLAY 6-A ORMOC ROAD, PHIL-AM HOMES SUBDIVISION, BARANGAY PHIL-AM, QUEZON 1105, THE PHILIPPINES +63 945-3159-345 monray04@yahoo.com ATATURK TOWER, FLAT # 11/A (LIFT #10), 22 KEMAL ATATURK AVENUE BANANI DHAKA 1213 01571744624 04/01/1973 KALOOKAN CITY Philippine Philippine PRIVATE SERVICE PERSONAL DETAILS TRAVEL DOCUMENT DETAILS 11. Passport No: 12. Type of Passport: 14. Date of Issue: 15. Date of Expiry: 16. Date of Last Visit to Bangladesh: 17. Last Visa No.: 18. Date of Issue: P7029725B 23/06/2021 2 2 /06/ 20 31 ORDINARY Government of the People's Republic of Bangladesh D.I.P Form-4(Free of cost) Department of Immigration & Passports Machine Readable Visa Application Form First / Given Name(s) Contact No.: Email: monray04@yahoo.com (as in the passport) DD / MM / YYYY DD / MM / YYYY DD / MM / YYYY DD / MM / YYYY MANILA THE PHILIPPINES * Name of Office / Bangladesh Mission: * Please Go Through The General Instructions Before Filling Up The Visa Form. * This Form Should Be Filled Up In Capital Letters. Put A Check [ √ ] In Appropriate Box. Single Seperated Married Divorced Widowed Engaged Invalid Annulled Cohabitating Deceased Spouse's Death Common Law None √ Others √ 13. Place of Issue: DFA MANILA Web Application 19. Place of Issue: 20. Date of Expiry: PAYMENT DETAILS 21. Name of the Bank and Branch: 22. Cheque/Bank Transfer/Chalan/Scroll No.: 23. Amount Deposited: 24. Date: NEW VISA , DD / MM / YYYY 25. Purpose of Visit: 26. Duration of Proposed Stay in Bangladesh: 27. Tentative Date of Arrival in Bangladesh: 28. Intended Number of Entries: 90 Day(s) 05/10/2021 DD / MM / YYYY Business Dependent Diplomatic Single Re-Entry Multiple Employment Investment Official Student Tourism Transit Others (Please Specify) √ √ 30. Date of Arrival 37. Duration of Proposed Extension: 36. Purpose of Extension of Visa: 32. Type of Visa: 31. Visa No: DD / MM / YYYY in Bangladesh: 33. Date of Issue: 35. Place of Issue: DD / MM / YYYY 34. Date of Expiry: DD / MM / YYYY 29. Name of the Father/Mother/Spouse/Other(Relation): EXTENSION OF VISA NO VISA REQUIRED FOR TRAVEL TO BANGLADESH 39. Father's Name: 47. Type of Visa: 42. Date of Arrival in Bangladesh: 48. Reason For Proposed NVR: 40. Mother's Name: 41. Spouse Name: Nationality: Nationality: Nationality: DD / MM / YYYY DD / MM / YYYY 43. Visa No: 44. Date of Issue: DD / MM / YYYY 45. Date of Expiry: 46. Place of Issue: 38. Intended Number of Entries: Single Re-Entry Multiple DD / MM / YYYY (Taka/US$) CHECK LIST Recommendation from concern Ministry Authority Security Clearance / Security Certificate Father's / Husband's / Mother's Visa copy Passport Copy, Last Visa and Last Arrival Page Father's / Husband's / Mother's Passport copy N. O. C from Sri Lankan High Commission Bi-Lateral Agreement / Multilateral Agreement Trade license of the sponsoring Company Payment Slip Over stay Payment Slip Marriage Certificate Birth Certificate Work Permit Affidavit Photo Income Tax Certificate of the Company TIN TIN Certificate of the Company Others I hereby declare that statements given above are true and will not request to refund my paid visa fee even if my Application is declined. Place: Date: DD / MM / YYYY Signature (RAYMOND ADRIANO CABUSLAY) Philippines 23/09/2021 Invitation letter √ √ √ √ TRANSIT/ON ARRIVAL VISA 53. Travelled by(Vessel's/Flight/Vehicle Name & No): 51. Date of Arrival in Bangladesh: 55. Purpose of Visit to Bangladesh: DD / MM / YYYY 52. Name of check post: 56. Duration of Proposed Stay: 54. From: 49. Amount of Investment (For Investor): 50. Name and Address of Company: Name of Mission : Embassy of the People's Republic of Bangladesh, Manila Chancery Address : Universal-Re Building, 2/F, 106 Paseo de Roxas, Makati, Metro Manila, The Philippines. International phone code : 63-2 (Manila) Telephone : 817-5001 & 817-5010 Fax : 816-4941 E-Mail : dutabash.phil@pacific.net.ph Telegraphic Address : BANGLADOOT, MANILA Office Time : 0900 to 1700 hrs. Local Time : GMT +8 hrs. Weekly Holidays : Saturday and Sunday Incorrect Correct POLICE VERIFICATION Memo No Date DD / MM / YYYY Information's are found If not correct: Reasons: Signature and Seal of Inquiry Officer Signature and Seal of Issuing Officer FOR OFFICIAL USE Reference No: Date: Amount of Fee: Visa No: Date: Date Expiry: Number of Entries Extension Re-Entry Multiple Entries NVR Date: Recipient's Signature Date & Seal Authorized Signature OA0000002579667